Archive for the ‘Hospital Administration’ category

Having served in healthcare senior leadership for over two decades, my tolerance level for various “healthcare norms,” that revolved around the sometimes-insensitive treatment and care of patients and their families had reached the breaking point. Consequently, at the end of my 40th decade when I became a hospital CEO, I arrived in the position with a quiver full of change arrows that were sure to shake up the status quo, and it did.Because I had entered the healthcare field some twenty years after most of my senior leadership peers, my life experiences were much more varied and non-traditional. For ten years, I had been a band and orchestra director in both City and Urban school districts. After that, I ran what became a successful arts organization in a rural area, and finally, served as the CEO of a convention and visitors bureau. It was during those years that I went back to school for another Masters degree in public management/health systems management.

When this CEO opportunity presented itself, I realized how each and every one of my life experiences could help me run a hospital, but not just any hospital. It was my vision to create a hospital that embraced all modalities used in integrative medicine with the ambiance of a fine hotel and the amenities of a health spa. We carefully scrutinized and then credentialed practitioners specializing in massage therapy, integrative nutritional counseling, acupuncture, osteopathic manipulation, pet and music therapy, reiki, and spirituality to name a few. These practices intermixed with traditional Western medicine became our new norm.

As the traditionalists who are reading this article begin to shake and scream about a lack of medical evidence, I can only point to the 19,000 papers written supporting the efficacy of acupuncture and the thousands of other medical papers written about the healing powers of music, massage, and such. In that same spirit, there is also the fact that the head is connected to the body and provides a mind-body connection that doesn’t fit neatly into the scientific “heal to the pill” mentality of our current system.As a non-clinician, non-scientist, it was easy for me to believe in things like “the Placebo effect” as well. It really didn’t matter to me why people got better. It was our goal to create a healing environment where people would not be immersed in fear and trepidation, where their loved ones could comfortably stay with them, and where unnecessary paging, and middle of the night prodding, and wake-ups were avoided as much as humanly possible.

It seemed to me that by training our employees at Disney University, allowing them to learn from the Ritz Carlton, and exposing them to sensitivity and emotional quotient training, we could create a healing environment. Because my philosophy was that you could not change the human condition, but you could change the condition under which humans worked, we also embraced an anti-bullying environment where employees were cherished and recognized for their contributions to the welfare of our patients.

How did implementing all of these ideas change healthcare in our little slice of Camelot? Our infection rate dropped to below 1% and stayed there for eleven years. (The national average is nine percent.) And I know we weren’t washing our hands more than they were at other hospitals. Of our peer hospitals, we had the lowest readmission rates, restraint rates, and lengths of stay, and when the naysayers saw these numbers, they said it was because we were not a large hospital. My belief was that we successfully had created a healing environment where our patient’s white blood cells were actually able to function to fight off infection. We were transparent, nurturing, and caring. We were not a “Healthcare FACTORY” where the patients became widgets in an Industrial Revolution model of care.

Music was always used in healing ceremonies by an indigenous man. Acupuncture has been deemed effective for over 5000 years. Massage makes you feel better, and sometimes your spine gets out of alignment and needs to be corrected. This is neither rocket science nor brain surgery. It’s about love, kindness, and caring, wrapped up in good Western medicine. Oh, and one more thing. Even with a palliative care unit, a hospice, we had the lowest death rate of our peer hospitals. I had always wanted to put up a billboard that said, “Come to our hospital . . . you’ll die less often.”

Nick Jacobs, among his other affiliations, is an officer of the Integrative Health Policy Consortium, which represents more than 600,000 IHM practitioners; president of the Clinical and Translational Genome Research Institute, which he founded; and a consultant to the Department of Defense in breast cancer research.

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Pennsylvanians received good news recently when the Pennsylvania Health Care Cost Containment Council reported that hospital readmissions and mortality rates continue falling locally and statewide.

The report shows these rates declining for a number of common types of treatments. It gives much of the credit to a “commitment of PA hospitals to provide quality care” and to the Affordable Care Act, which ties reimbursements to that quality care. This, in turn, encourages health care facilities to strive for improved mortality rates because doing so helps keep government funds flowing through their doors.

Regardless of the motivation, this is good news. But it’s not good enough.The mortality rate could be improved even more dramatically if more healthcare administrators and physicians would introduce integrative health and medicine practices into their services.

Integrative health and medicine (IHM), as defined by the American Board of Integrative Medicine and the Academic Consortium for Integrative Medicine & Health, recognizes the importance of the relationship between practitioner and patient. IHM focuses on the whole person, is evidenced-based and employs a wide range of appropriate therapies, healthcare professionals and disciplines to achieve optimal health and healing.

Integrative health practice includes treatments and therapies such as acupuncture; natural products; deep breathing; Tai chi and Qi Gong; meditation; massage; special anti-inflammatory diets; progressive relaxation; journaling; biofeedback; pet, music and dance therapies; hypnosis and guided imagery. When provided by a licensed or certified health care professional, IHM provides numerous benefits. It can decrease chronic pain, post-operative pain and the need for medications. It can improve patient satisfaction and shorten hospital stays. It can lower mortality rates. IHM methods also are relatively inexpensive.

Many places, including the Cleveland Clinic, have reported cost savings per patient, while also seeing reductions in patient anxiety, pain, and medications. During my tenure as CEO at Windber (Pa.) Medical Center, I worked with physicians, staff, and volunteers to create a healing environment by embracing all methods and therapies used in integrative medicine and combining them with the ambiance of a fine hotel and the amenities of a health spa. We carefully scrutinized and credentialed practitioners specializing in services such as aroma and massage therapy, integrative nutritional counseling, acupuncture, chiropractic manipulation, pet and music therapy, reiki and spirituality, to name a few.

In short, a healing environment permeated our facility.

Yes, we had our share of naysayers and opposition among physicians, allied health care professionals and others, but over time our infection rate dropped below 1 percent and stayed there for a decade. (The national average is 9 percent.) Of our peer hospitals, we had the lowest readmission rates, restraint rates and lengths of stay. Even with a palliative care unit to care for dying patients and their families, we had the lowest death rate among our peer hospitals.

For those who would say it was all coincidence because Windber is a small hospital, I would direct them to the 19,000 papers written supporting the efficacy of acupuncture alone, and then to the thousands of papers written about the healing power of music, massage and so many other treatments dismissed all too readily by traditional practitioners.

IHM practices are not at odds with traditional medical practices; rather, they enhance them. Yet in many hospitals and physicians’ offices, they are ignored, discouraged, even ridiculed. Such negative reactions result from ignorance, misinformation, prejudice and even greed — pharmaceutical companies, for instance, see no profit in promoting most IHM treatments, and some medical practices might earn less if, instead of scheduling patients for costly treatments or surgeries, they instead treated patients with acupuncture, spinal manipulation, massage therapy or even mindfulness.

Resistance to IHM is breaking down, but this shift in attitude needs to be accelerated. If you travel to Europe or Asia, you will see integrative medicine practices thriving because their value is acknowledged and embraced. In America, IHM beachheads are being established in health care systems and universities, thanks to such groups as the Family Medicine Education Consortium, Integrative Health Policy Consortium and the Academy of Integrative Health and Medicine, of which I am a co-founder. The academy includes among its member’s hundreds of licensed physicians who have successfully merged IHM with traditional medical practices.

Much remains to be done to more broadly spread the healing benefits of IHM, which will happen only when more patients take more responsibility for their health and demand IHM treatments, more physicians research and adopt them, and more insurance companies pay for them. When that day comes, there will be a lot more good news about mortality rates and other measures of medical care for Pennsylvanians and people all over the country to celebrate.

Licensure, regulation, medical evidence, and funding are four sure ways to speed up the process needed to allow integrative medicine practices to be embraced. If we begin with the assumption that money has a lot to do with everything medical in the United States, then we must look at the winners and losers and the WIFM’s? (What’s in it for me?) If you’re a practicing surgeon, and acupuncture or chiropractic care results in the patient not needing a surgery, that can be a financial threat to you. Let’s be fair, that probably doesn’t happen that often, but sometimes it does, and when it does, that’s money lost to your practice.

If you’ve spent four years in undergraduate school, four years in medical school, four or five years in a residency, and your educational debts amount to hundreds of thousands of dollars, the last thing you need is a clinical study demonstrating through medical evidence that thousands of patients won’t need your services, and your skills will become exponentially less in the demand.

On the other hand, if, like ophthalmologists who surround their practices with optometrists, orthopods did the same with chiropractors and acupuncturists, could that not create a steady stream of referrals for their practices?

Let’s face it, there is a role for all three of those professions, and there are skill levels in every profession and duties relegated to each that both overlap and potentially conflict. So, wouldn’t it be better to have the three practice as a team of professionals working together to help you?

“There’s not enough medical evidence” has been the hue and cry of the uninformed for years. Ironically, once traditional medical evidence is thoroughly interrogated, it’s not unusual to find numerous flaws in even the most accepted medical practices. We’ve seen slanted reporting in even the furthermost prestigious journals where various drugs, procedures, and devices have been proven to be ineffective years later.

There are over 19,000 papers that have been written and submitted to medical journals in which acupuncture has been endorsed and proven to be effective, but there never seems to be enough medical evidence for the naysayers.

Credentialing is a very challenging area as well. Not unlike the highly skilled surgeon with her medical degrees from the Sorbonne in Paris that is not permitted to practice medicine in the United States, there are sometimes economic and political reasons to limit the number of practitioners allowed in the United States. In my experience, by creating a hospital-based credentials committee that specializes in integrative medicine, the nay-sayers ability to discredit highly trained practitioners with different skills will become more limited.

Regulation may be the most difficult challenge in this discussion because, as we have come to know very well, political power can come from political contributions, and when it comes to regulations, those with the gold have more clout than those without. That is not to say that our politicians can be encouraged to be more flexible because they can. All it takes is for hundreds of constituents to stand in front of a Congressional office to encourage change to occur.

So, what are we really dealing with here? In 1910, the AMA put out a request for proposal to determine what should be taught in the medical schools of Canada and the United States and no physician would accept that assignment. Consequently, a Ph.D., Abraham Flexner, did, and his approach was to eliminate everything that wasn’t already proven science. From there we have evolved to a “heal to the pill” mentality where words like root cause and placebo have been dropped from the vernacular.

Finally, funding is the key. It has been proven time and again that integrative medicine practices can reduce health care costs exponentially. With that in mind, every bill that comes out of Washington ignores that fact, and funding for many of these well-documented practices is not present. There were over 5000 codes in the Affordable Care Act that were intended to fund such practices as acupuncture, but when the FAQ initially was released, it said, in essence, “Don’t worry about paying these codes.”

If you go almost anywhere in Europe and Asia and you will see integrative practitioners thriving because their value is acknowledged and embraced. Of course, we’re not professing that a massage therapist performs open heart surgery, but we do know that Integrative medicine can help to reduce costs across the board.

There are many good things that can come from Integrative medicine. You just need to be open-minded.

It was a brisk, early, spring, weekend morning and Joanna, then a 16-year-old, now mother of four, said that we needed a transition dog. Tessie, our part-golden, part-black lab, part-border collie was getting long in the tooth, and it was our custom to always bring a replacement puppy into the house when the older dog was beginning to head toward the rainbow bridge.

So, at Jo’s insistence, we drove to a dog pound about 23 miles away. When we got there, it was closed, but she kept pushing hard for a new puppy.

We then headed for another sanctuary for abandoned dogs, a no kill shelter. That shelter was about 31 miles in the other direction. We arrived right before closing time and were directed to a room that was filled with a half dozen beautiful, little, white puppies.

The puppy that jumped the highest and yipped the most was not our choice. It was instead it’s little brother, the most loving and cuddly of the brood. The volunteer said that he was probably part sheep dog and part poodle, but we really didn’t care what he was because he was adorable.

We paid our fee, packed him up, jumped into the car and headed home to our older dog Tessie for what would become months of mothering, teaching and unconditional love and patience. Jo named him Brody, and it fit him perfectly.

Tessie taught him how and when to go to he bathroom and, she taught him to be terrified of thunder, to bark at the meter readers, to play with the cats as if they were his very best friends, and to beg from me at the table. While Brody reminded Tessie how to play, he became her adopted puppy.

One evening, a newly roasted turkey was placed on the stove to cool. While working on my computer, I heard some noise in the kitchen. The next thing I heard was puppy feet on the steps and then a thump, puppy feet and a thump, puppy feet and a thump. Then Brody, the puppy appeared at my chair, his belly was completely distended, and he smelled of turkey breath. He and Tessie had eaten the entire thing. Kind of like the Butkus dogs on “A Christmas Story.”

Well, Brody grew to be the best dog and best friend ever. In fact, when my mother visited, she would hold complete conversations with him as if he was a human being.

In her obituary I wrote that “She often scolded her sons for not talking enough to their animals.” Somehow the Pittsburgh newspaper accidentally changed that line to “She often scalded her sons for not talking enough to their animals.” Only those who knew my mom could have ever appreciated the absurdity of that printed mistake. So, when people said they were sorry and scanned my body for burn scars, I knew why.

It was about six years after he joined us that I went on a heart healthy diet that excluded all meat, and, since I was the only sucker in the family who would sneak him table scraps, he had to follow my diet. He became a vegetarian dog. In fact, with some of the new fat free products and make believe meats, I always made it a rulethat if Brody wouldn’t eat it, I wouldn’t eat it either. That diet extended both of our lives.

After Brody died my life became doggy less, and I’ve never gotten over that disconnect, but with my schedule and all of the traveling that I do, it would not be fair to either the dog or to me.

So, I always spend considerable petting time with my daughter’s dog, Chipper, and believe me when I tell you that when I’m around, he is completely spoiled in every way because I’m just a dog kinda guy.

And in Tessie’s memory I added pet therapy at the hospital while I was a CEO, and I’m still convinced that those dogs provided as much healing as many of the drugs.

Sixty two years ago, George Orwell wrote the novel, 1984. He described a society controlled by government where the individual had no privacy, no real freedom, and was literally put into the equivalent of a drug induced state by the pabulum of mass media television. It was an intimidating forecast. But now the question; how much dumber can television get with shows like: “My Big Fat, Obnoxious Boyfriend,” “Real Housewives of Wherever,” and “Temptation Island?”

It was Marshall McLuhan, the Canadian educator, philosopher and academician who came up with terms like, “the global village, “medium is the message,” and the concept of the “World Wide Web” almost thirty years before Al Gore said he invented it. Marshall described the fact that the mass media was quickly taking over our ability to think independently as we rushed into the realities of Orwell’s Big Brother. He explained that we would be once again living in a world of tribal drums, total interdependence and superimposed terror as opposed to thought and feelings from rational analysis. Can you say, “Weapons of Mass Destruction?”

The World Wide Web has placed us in a type of tribal unity for which none of us were prepared. Why do you think tattoos are more in now than any time before 1500 B.C.? Piercings and tattoos make you “part of the tribe.” Hey, the majority of presidential candidate debate issues revolved around turning the clock back to the 1950’s, no web.

It appears that, because of this tribal unity, many very obvious changes have become accepted by our current culture. For example, according to columnist Rex Huppke, the fact that someone of any political party can say something that is completely false and stand by it makes facts meaningless and thus, dead. He goes on to theorize that, rumor and innuendo along with emphatic assertion are also part of this new communications standard.

Dartmouth political scientist, Brendan Nyhan professes that, “In journalism, in health and education, we tend to take the attitude that more information is better, and so there’s been an assumption that if we put the correct information out there, the facts will prevail.”Nyhan says that, “Unfortunately, that’s not always true.” Facts don’t seem to matter, and those who expose bogus facts are often more highly criticized than the person who misrepresented the truth in the first place.

We all know that the spin can change the view on any subject matter. In many cases, it’s the quality and persuasiveness of the argument, not the facts which becomes the issue. If you are on the right side of the spin, or if enough information can be put out there, the mass audience will be distracted from the facts, and confusion will reign supreme.

Fact: The United States has one of the highest infant mortality rates in the industrialized

Fact: Legislation has recently been proposed to take away additional funding for prenatal care.

Fact: The United States has fallen to “average” in international education scores and our State austerity measures include the laying off of teachers.

Fact: The incarceration rate in the United States of America is the highest in the world with only five percent of the world’s population, one-quarter of the world’s inmates are incarcerated in the United States.

Fact: Average annual cost per student for a public school education $8500; average annual cost per prisoner, $23,000.

See, many of you will not know if you should believe these facts. Some of you will fact check them. Others will say, so what? Some of you will look for my prejudices regarding this list, or you may be overwhelmed and say, “I can’t change any of this anyway.” Most, however, will not bother to read this far.

Twitter has become the new novelette and everything is a sound bite. As Jimmy Kimmel said, “What’s back and white and read all over? Nothing anymore.”

A few weeks ago, I mentioned that I was in Santa Fe, NM for an ACHE educational training course. Since then, I’ve been thinking a lot about some of the things that were said there by Master Instructor, Dr. Tom Atchison, Ed.D. (a/k/a, Yoda), the President and founder of Atchison Consulting Group. In fact, a few of the tidbits that he offered have been wedged in my brain to the point of obsession. It took me 40+ years to learn some of this, and now I am dying to share it. If you are a boss, a manager, or an employee, it applies equally to everybody, and the information has been valid for as long as mankind has roamed this earth. So, thanks to Dr. Tom, I can finally articulate it.

SSCS…yep, that’s it. SSCS. If you know what these letters stood for, you can stop reading now, but let me explain. In any group of workers, volunteers, employees, leaders, there are four very distinctive types of people:

Stars

There are the stars, and we all know the stars. No, not the “I’m going to get paid a million dollars to pose for a magazine” or for “selling the rights to my make-believe wedding” kind of stars. Rather, these are the bust your butt, be on the right seat in the bus, make it happen, hard working, cooperative, dedicated stars. They’re the people who lead the way and make things happen.

Skeptics

The next group of employees is the skeptics. Skeptics are generally really good people, sometimes slightly below the star category because they question everything in a meaningful, truth-seeking manner. The only problem with the skeptics is that they take a lot more energy than the stars. You must keep them informed, up to speed and appeased. Once they do get it, they are on board and make things happen in a big and important way. It’s just a little harder to get them there.

Cynics

Next we have the cynics. These people are insincere, and they are motivated by self-interest. They question everything, but more importantly, they dis everything, don’t cooperate and try to block every idea, action or activity. They are the ones who work behind the scenes to make sure that things don‘t get done, that people don’t cooperate and then openly criticize each and every idea no matter how sound the concept may be.

Slugs

Finally, there are the slugs. Usually they are nice enough people, but on a scale from one to ten with the stars being a ten, the slugs are exactly what they sound like. In fact, in reference to printing, the word slug came from traditional hot-metal printing where a strip of type metal is used for spacing that is less than type-high, hence a slug to fill in SPACE! They are space-fillers.

So, here’s what leaders who were present at this workshop were told. The cynics suck your life out of you by continuously challenging and undermining everything, and the slugs add no value to the organization. The problem with stars is that they are often taken for granted, or passed over because they are consistently amazing, and because we spend so much time dealing with the cynics and redoing everything the slugs don’t do.

His solution? Fire ‘em. (The slugs and cynics, that is.) Now if that seems a little harsh, maybe it’s because we all know and love both slugs and cynics. Unless you’re a tenured professor or the boss’s kid, it’s really tough to stay in a job where you do these sluggish and cynical things over and over again. Of course, if you fall into either of those categories, you could change!

Final advice? Be kind and nice and wonderful to the stars and the skeptics, and spend time explaining everything to the skeptics so that they embrace the concepts and dreams and vision and move forward with the rest of the team. Oh, yeah, and help the slugs and cynics find work, especially if you can find them work with a competitor because they will be the gift that keeps on giving cause they’ll probably be cynics and slugs for the next place, too, and all of those disgruntled patients and customers will come to you!

For the past three years, I have had a chance to dig heavily into the future, and I’m pretty convinced that the old saying, “Necessity is the mother of invention,” has never been more true than in today’s healthcare environment. What was a given before in healthcare management may no longer be so in the future, and since most hospitals only Chief Innovation Officer is the President him or herself, their tasks of visualizing, understanding, deciding and directing the future of the organization will be shifting even more heavily from quantitative deciding-and-directing to the more qualitative visualizing-and-understanding side of this leadership equation.

Although I understand the reluctance of most CEO’s to be on the bleeding edge of creativity, my experiences at my former positions can significantly reduce or mitigate the majority of risk from any decision regarding innovation.

Our new competitive environment has an insatiable appetite for information, access and connectivity and it’s a well known fact that a periodic injection of chaos fosters creativity and forces your co-workers to leverage technology. Because most organizations already have an environment that is built on trust and collaboration, injecting a little creativity can put their CEOs in more of a position to be the orchestrator and the inspirer.

That Used to be Us is the new book by Thomas Friedman and Michael Mandelbaum in which they analyze four specific challenges Americans face as a nation—globalization, the revolution in information technology, the nation’s chronic deficits, and our pattern of excessive energy consumption—and spell out what they believe needs to be done to sustain the American dream, and achieve true supremacy based on innovation and excellence.

As an innovator and futurist, several sections of this book captured my imagination and brought closure to a myriad of beliefs that I have instinctively embraced over the past few decades. When my responsibilities revolved around the CEO position, I always saw my job as being a contributor to an environment where creative decisions were embraced allowed to happen and then those innovators were rewarded and inspired to keep going.

As the co-founder of a Research Institute, one issue that continually resonates with me is that “We don’t have enough ‘rogue’ CEO’s in healthcare administration to take risks so that the rest can benefit from both their successes and knowledge.”

I have to admit that the 12-credit, continuing education course I signed up for was not supposed to be fun. In fact, I fully expected it to be two full days of classroom work, in a room with no windows, followed by exactly zero recreation time. I knew it would include a working breakfast, working lunch and a couple of bathroom breaks. I’ve done this before in places like Hawaii, Fort Lauderdale, Cape Cod; you name it. And, because of my work schedule, I usually fly in, take (or teach) the course, sleep in some no-nonsense business hotel, then head home the following day. What have I been thinking about for all of these years?

When I arrived in Albuquerque, New Mexico on Sunday and went to the rental car agency desk for my trip to Santa Fe, I should have guessed that something big was going on that week. The service representative told me that she could not rent me the compact car that I had ordered, but, in fact, had to rent me one of those black Secret Service type RV’s that hold eight people, a few rocket launchers and a small quad, but she’d cut me a break on the price. When I asked her about gas mileage, she put her head down and said something like, “Drill, Baby, drill.” The helpful young lady informed me that the Albuquerque International Balloon Festival was taking place throughout the week, and there were virtually no rooms and very few rental cars available anywhere in the area.

Because I had run a visitors bureau in the 80’s, I had seen pictures of hundreds of hot air balloons floating over New Mexico and knew there was such an event, but didn’t realize it was, you know, this week.

My course was being offered by an organization called the American College of Healthcare Executives; the recipient of many thousands of my dollars over the last 25 years. You see, they provide you with a credential that some hospital CEO’s have, and even when you’ve stopped running hospitals, it is important to keep paying them and taking courses in order to maintain the credential until at least six months after your death.

One of the unusual things about this credential is that it is spelled FACHE. My former assistant once asked me why I signed my name as Nick Jacobs, FACHE, but she pronounced it “fake.” It actually means Fellow in the American College of Healthcare Executives, but, really, her pronunciation was more fun…and a great conversation starter, too.

The rain started during my 5:00 AM trip to Santa Fe and continued for two days. So, because the balloons always fly very early in the morning, I never saw even one of them, but on my way to the airport this morning in the shuttle, I overheard a man and his wife discussing “the cow.” He went on and on about how big “the cow” was. It never dawned on me that he was talking about a cow balloon. Finally, when he said, “Those were the biggest set of udders I’d ever seen,” I had to interrupt and question this discussion. At that point he explained to me that the basket was in front of the udders, but I still didn’t get it until he laughed and said, “Heck, man, it was a hot air balloon the size of the Astrodome.” Hence, the title of this post.

I’m glad New Mexico, the Land of Enchantment, isn’t wine country. Could you imagine finishing that 22nd sample of some great vintage, walking outside and seeing that colossal, airborne cow coming at you?

The course was great, the hotels were clean, and the people were nice, but missing that cow has me really upset. I mean, how many chances do you have in your lifetime to see 600 hot air balloons flying overhead? How many days in a lifetime provide a person with that type of visual opportunity?

It’s time to stop and smell some roses. From now on, I’m only going to go to courses that end at noon.

The U.S. poverty statistics came out a few weeks ago, and things haven’t been this bad since 1993. Look to your left; look to your right. About one in every six Americans is now considered to be living below the poverty level. In 1993, the average new house was $113,000, the average income was $31,230, the average car was $13K, and tuition at Harvard was at $23,500. By 2010, you could nearly double every one of those numbers except the average family income which rose only to $50,000, instead of the $62,500 it should have been.

One of my favorite comparisons has always been that of Harvard’s tuition, which hovered right around $40,000, and the cost to keep a prisoner in jan American jail for one year, by comparison: about $45,000. Now, if you extrapolate the number of people in U.S. prisons based on the entire population of the United States, it works out to about one in every 31 adults. Between 2.3 and 2.4 million Americans are behind bars. America incarcerates nine times more people than Germany and 12 times more people than Japan. That adds up to nearly $104 billion dollars a year in U.S. prison costs alone.

The folks on Wall Street and in Washington D.C. who so cunningly helped to put us into this financial mess are, by and large, not in prison, and the percentage of inmates that are minorities is staggering. An estimated sixty-eight percent of prison inmates were members of racial or ethnic minority groups. Are our prisons full because our minorities are bad people, or are they full because their jobless rate is 40% higher than that of Caucasians?

We’re also spending about $700 billion per year on our military. For reference, the rest of the entire world combined spends nearly that same number. At $1.4 trillion a year, that adds up to $236 per capita worldwide on defense, and we still have 24,000 nuclear missiles lying around; enough to blow up the planet plenty of times.

According to the World Bank, over 1 billion people live in conditions of extreme poverty and 15-20 million people are starving every year. I saw another set of figures today regarding food subsidies in the United States. It wasn’t a figure indicating our generosity toward these one billion poor people, it was that between 1995 and 2010, our Congress voted to provide $260 billion to continue agricultural subsidies. Okay, maybe some of that makes sense, but what about the $17 billion that is going to use the American people’s money to create artificial incentives to produce ingredients that eventually become hydrogenated fats?

We are an obese nation, yet we paradoxically continue to publicly subsidize high fructose corn syrup and hydrogenated fats, so that our obesity, diabetes and heart disease epidemics continue unabated. Sheer folly, or is this about some really big businesses, with some really good lobbyists?

Maybe it’s time to look at things a little differently. We all know that testosterone makes us physically strong, but it also makes us more aggressive and competitive. This testosterone overload has continued to result in war and violence being accepted as the normal way to settle things, and, except for the supposed economic benefits of war, we also know that war is just crazy. It kills and maims people, and diverts resources that might be otherwise be utilized elsewhere.

We’ve seen time after time that if you are brutal and retaliatory with people, they will learn to hate and fear you. However, if you give people love, compassion and respect they will eventually return the compliment. Maybe we should take a break from all of this running-the-world stuff, and focus on doing the best that we can for the human ace. Maybe we should walk the talk of our religious leaders for a change.

We ran a hospital like that for over a decade and it prospered economically and grew. This concept is neither rocket science nor brain surgery. It’s the most uncommon of things in our current culture, common sense.

We cannot change the human condition – but we can change the conditions under which humans live and work!

“What if you were given that choice? For real. What if it weren’t just the hyperbolic rhetoric that conflates corporate performance with life and death?…What if a well-informed, trusted authority figure said you had to make difficult and enduring changes in the way you think and act? If you didn’t, your time would end soon — a lot sooner than it had to. Could you change when change really mattered? When it mattered most? “

Then, he articulates the actual outcomes of studies. Talk about “tough love.”

“…The odds? You want the odds? Here are the odds that the experts are laying down, their scientifically studied odds: nine to one. That’s nine to one against you. How do you like those odds?”

So, as a nation, as healthcare leaders, as human beings in a country that is currently facing the realities of potential economic disintegration, we are faced with what can only be described as another enormous challenge: a financially unsustainable healthcare system. Regardless of your politics, regardless of your personal beliefs regarding the competency of the federal government and its ability or inability to fix anything, the law has been passed, the train is moving and it’s moving directly toward you and your hospital.

Over the past three years, we have repeatedly presented money-saving and money-making ideas to help begin to position your healthcare organization for the impending tsunami of change that has been launched. As a veteran of TQM, Six Sigma, Baldridge, and a half dozen other consultant-delivered “fixes,” I’m sure I can hear the words going round and round in your head, but, not unlike the clamor that arose from the HMO/PPO days of yesteryear, this ACO/SSP challenge has to be met and dealt with intelligently, and it has to be done in such a way as to not destroy your hospital or health system.

Let’s face it, we’re all pretty smart folks. We’ve all been in permanent white water for years, and the last thing that many of us want to take on is the ole captain of the ship without a rudder, during a hurricane while the lighthouses are being moved around on the shore. But, once again, it’s here. It’s upon us, and we must deal with this challenge in an intelligent manner.

One possible alternative for smaller organizations is the SSP, a Shared Savings Program, the alternative put forth by CMS, the Center for Medicare and Medicaid Services, to a full-blown ACO, an Accountable Care Organization. Either way, however, SSP or ACO, the primary, overarching goal is to try to improve quality, decrease costs, and provide patient-centered care in a meaningful way. Not unlike the old HMO/PPO days, the effort requires infrastructure (and plenty of it…the average participant in the demonstrations spent about $1.7M on this one, single aspect of managing the healthcare new world order.)

What do you need? Well, you need 5,000 patients, to start. Then:

Decide if you will use Medicare only or other patient groups.

Determine the exact service area that you will target. How many square miles?

Decide which reimbursement model will work for your organization, i.e., an SSP that is more risk-based, or capitated.

Identify patient-related strategies such as enhanced experience for the patients or faster throughput as well as reduction in errors.

Then, dig deep into the organizational strategies for improvement.

Let’s face it. From 2001 until 2008, total Medicare inpatient margins for acute care hospitals have decreased every single year. (Source: Journal of Healthcare Management) Reimbursements have decreased while your bad debt has increased. So, regardless of your tolerance for risk or change, cost control simply must become the culture of every healthcare organization in the United States. We have seen the variances in costs based on geography in this country and treble charges in one area as opposed to another will not go on into the future. Joel Allison, CEO of Baylor Health has stated that this movement is “All about…focusing on wellness, on prevention.” (Arnst, 2010)

We need our primary care docs, we need physician participation to a far greater degree than we currently have, and, at the same time, the physicians must be partners in the effort. Employing physicians is also a critical element.

F. Nicholas “Nick” Jacobs, FACHE, is the international director for SunStone Consulting, LLC. In that capacity he provides transformative, strategic solutions to companies, organizations and individuals. He has more than 20 years experience in hospital management, with an acknowledged reputation for innovation and consumer-centered leadership.
Throughout his career, Mr. Jacobs has developed a reputation for innovative leadership that focuses on effective delivery of service that puts the patient’s needs and concerns first. He speaks extensively on this topic and has spoken for the American College of Healthcare Executives, American Hospital Association, and the World Health Organization numerous times.